Comparison of endoscopic and non-endoscopic lumbar decompression outcomes using ACS-NSQIP database 2017-2022

Recently, spine surgeons have begun adapting endoscopy to perform decompressive laminectomy which has been reported to provide smaller incisions and potentially lower risk of complications compared to traditional techniques. This study aimed to compare patient characteristics and adverse outcomes between patients undergoing endoscopic vs. open or minimally invasive (MIS) laminectomy using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database.

Using the ACS-NSQIP database from 2017 to 2022, Current Procedural Terminology (CPT) code of 63030 or 62380 were used to filter the dataset between open/tubular retractor-based and endoscopic single-level lumbar decompression cases, respectively. Overall, as collected, the endoscopic group consisted of 336 patients and the non-endoscopic group had 55,111 patients. The groups were compared to evaluate the patient characteristics and adverse events within 30 days after their operation. Outcome measures compared were operative time, length of stay (days), adverse outcomes [superficial infection, deep infection, organ/space infection, wound dehiscence, pneumonia, unplanned intubation, pulmonary embolism, ventilator >48 hours, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke/cerebrovascular accident (CVA) accident, cardiac arrest, myocardial infarction, blood transfusion, deep vein thrombosis (DVT), sepsis, and septic shock], 30-day readmission, return to operating room (OR).

After propensity score adjusting for age, sex, race, body mass index (BMI), American Society of Anesthesiologists (ASA) class, and Charlson Comorbidity Index (CCI), endoscopic patients had less total adverse outcomes than open (1.2% vs. 4.8%, P=0.01), with significantly lower rate of blood transfusions (P<0.05) compared to the non-endoscopic group.

Patients who underwent endoscopic lumbar decompression demonstrated a significantly lower rate of total adverse events and significantly lower rate of blood transfusions compared to their counterparts. This data from the ACS-NSQIP supports the reported benefits of endoscopic technique in the current literature. As endoscopic surgery becomes more widely utilized throughout the United States, more data will become available for further studies.